Molina Medicare Options Plus HMO SNP is a Medicare Advantage Prescription Drug Special Needs plan, for people with both Medicare and Medicaid. The plan offers all the benefits of Original Medicare and much more. You are eligible for Molina Medicare Options Plus (HMO SNP) if you:
- Are entitled to Medicare Part A
- Are enrolled in Medicare Part B
- Are entitled to Medicaid
- Reside in the Molina service area
To find out more about Molina Medicare Options Plus (HMO SNP) plan benefits, please click on the Plan Materials in the left hand column. They include:
- Enrollment form - Please complete this form to enroll in the plan. If you need help in completing the form, please contact Molina Medicare at 1-866-403-8293 (TDD/TTY: 711) from 8 a.m. to 8 p.m Monday - Sunday. You may enroll in Molina Medicare Options Plus (HMO SNP) any time of the year.
- Evidence of Coverage (EOC) - The EOC explains your rights, benefits, and responsibilities as a member of Molina Medicare. It also explains our responsibilities to you.
- Summary of Benefits (SB)/Directories - The Summary of Benefits outlines your plan premium, benefits, copayments and coinsurance for the current calendar year. The Provider Directories outlines your plan's network of Primary Care Physicians, Specialists, Hospitals, Skilled Nursing Facilities, Outpatient Facilities, and Supplemental Benefit Vendors.
- Low Income Subsidy (LIS) Chart - This table shows you what your monthly plan premium will be if you get extra help from Medicare in paying certain prescription drug costs.
- Forms – The following forms may be helpful and are available through this link: Appointment of Representative Form (CMS-1696), Coverage Determination Request Form, Drug Determination Request Form, How to Request a Redetermination, and Pharmacy Direct Member Reimbursement Form.
- HIPAA, which stands for the American Health Insurance Portability and Accountability Act of 1996, is a set of rules to be followed by doctors, hospitals and other health care providers.
- Notice of Privacy Practice - This notice describes how medical information about you may be used and disclosed. It also explains how you can get access to this information.
- Contact HIPAA - This link provides information on how to contact the HIPAA office in your state.
- Over-the-Counter (OTC) (2013) – This is a benefit offered by your plan that can be used many different ways. We are partnered with CVS Caremark so that you can order the health and wellness products you need most. You can order online or place an order by telephone. Please use the link to view the catalog of items available as well as an explanation of how to place your order.
This information is available for free in other languages. Please contact our customer service number at 1-800-665-3086 TTY 711 Monday - Sunday, 8:00 am to 8:00 pm local time, for additional information.
Printed copies of information posted on our web site are available upon request.